Provider Demographics
NPI:1447009915
Name:FARMAVIDA LLC
Entity type:Organization
Organization Name:FARMAVIDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAISONET
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-891-6539
Mailing Address - Street 1:HC 3 BOX 30402
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9197
Mailing Address - Country:US
Mailing Address - Phone:787-891-6539
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 119.5 BO CAIMITAL ALTO
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-9197
Practice Address - Country:US
Practice Address - Phone:787-432-1645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy